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ICM -- Cardiology > Pericardial Disease > Flashcards

Pericardial Disease Flashcards

1
Q

Most common cause of acute pericardial disease?

A

Idiopathic

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2
Q

Causes of Pericarditis

A 
Radiation
Neoplasm
Trauma
Autoimmune
Metabolic (Hyperthyroidism, Uremia)
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3
Q

Viral causes of Pericarditis?

A

Coxsackie A or B, Echovirus, Mumps, Adenovirus, and HIV

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4
Q

Bacterial causes of Pericarditis?

A

TB, pneumococcus, streptococcus, staphylococcus, legionella

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5
Q

Fungal causes of Pericarditis?

A

Histoplasmosis, Coccidiomycosis, Candidiasis, Blasto

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6
Q

Cardiac causes of Pericarditis?

A

Early infarction pericarditis
Late post cardiac injury (Dresslers’)
Myocardiits
Dissecting aortic aneurysm

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7
Q

Drugs that cause Pericarditis?

A

Procainamide
Isoniazid
Hydralazine

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8
Q

Acute Pericarditis pathologic anatomy

A

Usually fluid accumulation – usually serous
Bacteria (Purulent) and Tumor Cells
Fluid may resolve or form adhesions

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9
Q

Chronic Pericarditis pathologic anatomy

A

Roughened Heart Surface

Bread and Butter

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10
Q

Clinical Features of Pericarditis?

A

Chest Pain
Pericardial Friction Rub
ECG Changes
Pericardial Effusion

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11
Q

Acute Pericarditis Chief Complaints

A

Chest Pain unrelated to exertion
Fatigue, Dyspnea, Malaine
Fever

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12
Q

Describe the chest pain of Acute Pericarditis?

A

Sharp, Stabbing, Sudden Onset
Worse on deep inspiration and lying flat
Better Leaning Forward

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13
Q

Describe a Pericardial Rub

A

From friction btw layers of pericardium
Superficial, scratchy, leathery sound – higher than diastolic filling sounds
Best heard over left sternal border

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14
Q

Acute pericarditis findings

A

Typical history, exam ECG
Normal CXR most of the time
Autoimmune serologies
Pericardiocentesis if you suspect infection or cancer

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15
Q

What EKG changes are expected with Acute Pericarditis? (Overall)

A 
Sinus Tachy
Diffuse Concave ST changes
PR depression
PR elevtion+ST depression in aVR
Diffuse -- not associated with a specific vessel
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16
Q

EKG changes 4 stages

A
  1. Hours to Days - Diffuse ST Elevation, PR depression
  2. First week – Normalization of ST and PR
  3. Diffuse T wave inversions
  4. Normalization of EKG or indefinited persistence of inversions (in chronic)
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17
Q

Complications of Acute Pericarditis?

A

Pericardial Effusion and Tamponade
Constrictive Pericarditis
Relapse

18
Q

Idiopathic and Viral Pericarditis Treatment?

A

Combination of NSAIDS (2 weeks) and Colchicine (3 months)

19
Q

Treatment for Pericarditis Post Acute MI

A

Aspirin and Colchicine

20
Q

Who can’t have Colchicine?

A

No good with severe renal or liver disease, blood dyscrasias, or GI motility disorders

21
Q

What do you give to patients with symptoms refractory to standard therapy? Whats the problem?

A

Glucocorticoids

Increased risk of recurrence

22
Q

Causes of Pericardial Effusion

A 
Acute Pericarditis
Radiation
Malignancy
Cardiac Perforation
Hypothyroid
Connective Tissue Disease
Aortic Dissection
23
Q

What is electrical alternans

A

Alternating large spikes in EKG from heart swinging around in the fluid filled sack

24
Q

X ray Pericardial Effusion findings

A

Massive looking heart

25
Q

Pericardial Tamponade Presentation?

A

CHF symptoms with clear lungs
Unexplained signs of R Heart Failure (Edema, JVP)
Cardiomegaly on CXR
Sinus Tachy, Electrical Alternans

26
Q

Pericardial Tamponade Pathophysiology?

A

Fluid Increases pericardial pressure
Pressure impedes diastolic filling of LV and RV
RV and LV diastolic pressure rises
SV and CO decrease
Systemic BP drops, pulse pressure narrows, HR up

27
Q

What is Pulsus Paradoxus?

A

Fall of systolic BP of over 10 mmHg with inspiration

28
Q

Why does Pulsus Paradoxus happen?

A

Inspiration increases venous inflow to RV, RV expansion. W/ compressive fluid, the increase in return causes a septal shift, impinging on LV volume.

29
Q

Physical findings in Pericardial tamponade?

A 
Sinus tachycardia
Hypotension (late w/ narrow Pulse Pressure)
Elevated JVP w/ loss of Y descent
Edema
Pulsus Paradoxus
30
Q

Three ECG findings of pericardial tamponade

A

Sinus tachycardia
Low Voltage
Electrical alternans

31
Q

Important unique component of Pericardial Evaluation

A

Right heart catheterization (Equalization of pressures)

32
Q

Treatment for Pericardial Tamponade

A 
Medical Emergency
IVF (temporizing)
AVOID diuretics, vasodilators
Vasopressors
Pericardiocentesis/Window
33
Q

What is Constrictive Pericarditis?

A

Chronic thickening/scarring of pericardium leads to encasement of the heart and impaired diastolic filling of LV and RV.

34
Q

Name for the sign associated with constrictive pericarditis

A

Dip and Plateua or Square Root sign

35
Q

Most common cause of Constrictive Pericarditis

A

Idiopathic or Viral

36
Q

Clinical Presentation of Constrictive Pericarditis

A 
Slow, indolent process
Unexplained RHF (JVP w/ X and Y)
Often misdiagnosed as Cirrhosis
37
Q

What is Kussmaul’s Sign?

A

Rise in JVP with Inspiration

38
Q

How are the jugular venous patterns between tamponade and constriction

A

Tamponade – No Y

Constriction – Kept the X and Y

39
Q

Pericardial Knock comes from…

A

Rapid Atrial Filling

40
Q

Which side of the heart is more influenced by constrictive Pericarditis?

A

Simutaneous L and R heart – Equalized diastolic pressures

41
Q

Therapy for constrictive pericarditis?

A

Diuretics (but don’t drop the filling pressure too low!)

Pericardial Stripping

ICM -- Cardiology (9 decks)

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